Because of the high prevalence of tobacco use in countries of
Central and Eastern Europe, public health officials in many of
these countries have designated as a priority the prevention of
smoking initiation among youth. In 1995, a nationally
representative survey in the Republic of Hungary documented that
35.8% of 16-year-old students in that country had smoked cigarettes
during the preceding 30 days (1). To better characterize smoking
among youth in Hungary, the Field Epidemiology Training Program,
Hungarian Ministry of Welfare, conducted a cross-sectional survey
in Budapest (1995 population: 1,906,798) among secondary school
students aged 14-18 years. Specific objectives of the survey were
to assess the prevalence of cigarette smoking among these students,
determine factors associated with higher prevalences, and describe
the smoking habits of current cigarette smokers. This report
summarizes the findings, which indicate that one third of all
students smoked; half of all 18-year-olds smoked; and of those
students who smoked, 41% most frequently smoked an imported,
internationally recognized cigarette brand.

Among the 105,209 Budapest students aged 14-18 years,
approximately 80% attended traditional public high schools, and 20%
attended public vocational/technical schools. A sample of students
was selected from a stratified sample of the 199 secondary schools
in Budapest. Twenty (80%) traditional high schools and five (20%)
vocational/technical schools were selected with a probability
proportional to their size. Classrooms in these 25 schools were
then randomly selected. During 3 weeks in January 1995, all 2878
students in attendance completed a pretested, standardized
questionnaire that included questions translated from the U.S.
Youth Risk Behavior Survey (2) and that asked about culturally
relevant factors possibly associated with smoking. Current smokers
were defined as students who reported having smoked at least one
cigarette during the preceding 30 days. Of the 2878 students, 79
(2.7%) were excluded because their smoking status could not be
determined. Epi Info 6.02 was used for data analysis that accounted
for the stratification and clustering of students within
classrooms; 95% confidence intervals (CIs) were calculated using
SUDAAN (3).

Among the 2799 students, 987 (35.3%) (95% CI=30.6%-39.9%)
reported current smoking (Table_1). Although the prevalences
were
similar among male and female students (prevalence odds ratio
{POR}=1.0; 95% CI=0.8-1.5), students aged 18 years were more likely
to smoke than students aged 14 years (47.9% and 23.8%, respectively
{POR=2.9; 95% CI=1.3-6.6}). The prevalences of current smoking also
were higher among vocational/technical students than traditional
high school students (53.1% and 31.0%, respectively {POR=2.5; 95%
CI=1.6-3.9}); among students whose friends smoked than those whose
friends did not smoke (42.6% and 6.8%, respectively {POR=10.1; 95%
CI=7.5-13.7}); among students who reported that they had seen a
teacher smoking during the school year than those who had not seen
a teacher smoking (37.3% and 19.0%, respectively {POR=2.5; 95%
CI=1.8-3.6}); and among students with a family member who smoked
than students whose family members abstained from smoking (40.7%
and 27.0%, respectively {POR=1.9; 95% CI=1.6-2.1}). The prevalences
of smoking were similar among students who received instruction at
school about the harmful health effects of smoking and among those
who did not receive such instruction (POR=1.0; 95% CI=0.9-1.1).

Among current smokers, during the preceding 30 days, 17.3%
smoked greater than or equal to 11 cigarettes daily, 38.0% smoked
daily, and approximately half (51.0%) smoked on school property on
at least 1 day (Table_2). Approximately 60% of current smokers
smoked a variety of brands of cigarettes. Current smokers reported
that the brands they most frequently smoked were Hungarian brands
(Multifilter {57%} and Sopianae {33%}) and a U.S. brand (Marlboro
{41%}).

Editorial Note

Editorial Note: The findings of the survey described in this report
indicate that in 1995, a substantial proportion (35%) of secondary
school students in Budapest reported smoking cigarettes. This
prevalence is identical to that among U.S. students in grades 9-12
during 1995 (2); however, the findings for the United States
reflected a national sample of persons who resided in urban and
rural areas, and the findings for Hungary reflected a sample of
persons who resided in one large urban area. The prevalence of
smoking in Budapest increased directly with age and was 48% among
18-year-old students. Worldwide, about half of persons who initiate
smoking during their teenage years and continue to smoke cigarettes
regularly will die as a result of a tobacco- related disease (4).
The death rates for diseases attributable to smoking are higher in
Hungary than in most other developed countries (4,5).

A survey of the prevalence of smoking among adolescents in
European countries during 1993-1994 indicated that among five
countries in central and eastern regions (Czech Republic, Hungary,
Republic of Poland, Russian Federation, and Slovak Republic),
approximately 10% of adolescents reported smoking cigarettes at
least weekly. However, the overall prevalence of cigarette smoking
for all age groups in Hungary is among the highest of all countries
in central and eastern Europe. Each year from 1976 through 1990,
annual average per capita cigarette consumption in Hungary was
higher than the combined average for all central and eastern
European countries (5).

The finding that most current smokers varied the brand of
cigarette they smoked may reflect the ease with which students can
purchase individual cigarettes at newsstands and other stores in
Hungary. Students may vary the brand of cigarette they smoke based
on the availability and cost of individual cigarettes. In general,
in Budapest, imported western brand-name cigarettes are more
expensive than central and eastern European brand-name cigarettes.

To decrease the initiation and prevalence of smoking in
Hungary, health officials are developing a population-based tobacco
education campaign that will include a pre- and postintervention
smoking prevalence survey to evaluate the impact of the program. In
addition, a pilot intervention project is being planned in a large
city (Szekesfehervar) to decrease exposure to passive smoke
(environmental tobacco smoke); this project will include both a
general media campaign and a program to educate kindergarten
children and their parents about the hazards of passive and active
smoking. Public health officials in Budapest also have recommended
that teachers who smoke do so in restricted areas that are out of
sight of students.

Although cigarette advertising that actively promotes the
purchase of cigarettes is prohibited in Hungary, such advertising
is common in many public locations, including sports arenas, large
city squares, housing complexes, and busy traffic intersections.
Public health officials also have recommended stronger enforcement
of the ban on cigarette advertising (E. Morava, Hungarian Ministry
of Welfare, personal communication, 1996).

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